One the Whole, I’ve Had Better Nights

A year or so ago, reflecting on his then-recent heart attack and subsequent surgery, an uncle mentioned almost as an aside that the attack hadn’t been all that painful. It was alarming, certainly, and left him exhausted and needing weeks of recovery, but the actual pain of the attack itself turned out to be surprisingly manageable.

From my uncle’s comments, I’d guess his discomfort level to have been around three on a scale of ten—three being equivalent to a persistent headache, five matching the re-election of Victoria’s Labor government, seven replicating the feeling after watching any random thirty minutes of ABC comedy and ten being right up there with hearing US Vice-President Kamala Harris’s laughter.

Spared his appointment with the Reaper,
Tim Blair will continue to appear in every Quadrant.
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You’d take the three every single time. Anyway, not thinking I’d have much use for this information in any brief time frame, I stored it away for revision in perhaps a couple of decades—when I might be either in or approaching cardiac arrest country.

And then, in January, I had a heart attack. At fifty-seven.

It turns out that a near-lifetime of smoking, drinking and eating whatever I pleased had somehow advanced the whole cardiac drama timeline. Who knew? So on January 2, wife Nadia drove a barely-ambulatory me to hospital, grey of colour, with intermittent pain radiating across my jaw and tingling in both arms.

She’d accurately diagnosed the situation’s seriousness and decided to save my life, while I’d aimed to sleep it off. Seriously, that was my plan. It would have been a long sleep.

Hospital staff were also quickly alert to my circumstances, conducting a rapid sequence of tests before guiding me to a kind of halfway operating room—not quite a full theatre, but a few steps up from a basic ward. At this stage my recollection blurs a little, because I was shot up with a dose of fentanyl in advance of whatever treatment was to follow.

Overhearing hospital staff mention fentanyl, an incredibly potent painkiller, was the first direct hint that I was in very deep trouble. That stuff isn’t thrown around for fun, at least in Australian hospitals. The next hint came when a nurse put her hand on my shoulder and advised that I try to stay calm, because “things are about to get really intense”.

As medical predictions go, this was precisely opposite to all those early 2020 Covid forecasts that suggested entire healthy populations should prepare to be erased. Things did indeed get really intense—beginning with the bedside appearance of what looked to be the hospital’s complete staff, a number of whom instantly set about trying to find any veins and arteries able to accommodate intravenous drug lines.

Time being of the essence, they weren’t especially delicate. Quite the contrary. Those determined and physically powerful men and women went at my wrists as though my life depended on it. Which it obviously did, pushing lesser concerns—a certain patient’s wincing and twitching, for example—far aside. Bruising from those initial, frantic arterial explorations lasted for nearly a month.

Frankly, I wish it was still there. If ever I wanted a reminder about the importance of long-term positive results (me being alive) over intense but brief irritation (me carping about a few needles), all I’d need to do is look down. Maybe I should get a bruise-replica wrist tattoo.

Readers who have experienced being hooked up to IVs may be puzzled by all this talk of arterial-searching complexity. For that matter, I’ve previously been attached to IV lines myself a time or two without any associated difficulties, much less any visible and lasting signs of trauma.

But this time was different. Inserting needles is no easy matter when a chap is timing out and his arteries have collapsed due to catastrophically low blood pressure. Picture healthy, blood-inflated arteries as being like properly cooked rigatoni or penne pasta: tubular, and either round or oval in cross section. Even under life-or-death pressure, those are reachable targets.

Well, my arteries had become pasta of a different kind. Those medicos demanded penne, but the kitchen was only serving flat, ribbon-like tagliatelle. That’s apparently what happens to an otherwise serviceable circulatory system when blood pressure falls from a usual 130 over 80 to 34 over an unknown number somewhere south of 17.

There was a problem, for a while, with obtaining the second or diastolic figure. The device’s readout began at 17, and I’d fallen below even that. When my blood pressure finally responded to IV-delivered adrenaline—on the pasta chart, my arteries were now at semi-functional bucatini level—a doctor victoriously declared that I was “on the board”. Always nice to hear.

In fact, much of the chatter back on January 2 was nice to hear. Experienced medical types dealing with cardiac emergencies are, as you’d expect, very good at minimising a patient’s concern. This is in their professional interests as much as it is in the interests of a patient’s wellbeing. The last thing medics need when dealing with these cases is someone in a screaming death panic.

Medic-patient communi­cation—there was a surprising amount, considering the circum­stances—was for the most part usefully calming and upbeat. Even entertaining. I’d occasionally catch darker lines, however, being exchanged between staff. “Are the paddles ready?” a worried-looking doctor quietly asked his colleague at one point, and I don’t think they were planning any post-procedural ping-pong games.

Keeping things calm was obviously the reason I wasn’t directly informed for some time, despite all the ECG monitoring and other such heart-related activities, that I’d actually had a heart attack. Nadia, in the waiting room, learned about it before I did—thankfully from an expertly gentle staffer.

It was annoying, though, being scooped by the missus on my own story. On the other side of several doors, wondering about my precise status, I eventually thought to ask an all-bases-covered question: “Have I had a heart attack, am I having a heart attack, or are we trying to stop a heart attack?” The response: all three.

Painkillers couldn’t completely blank the full impact of various needles and inserts, but they did have the curious effect, also reported by others who’ve endured this type of drama, of making me feel like a heart-treatment spectator rather than a central and relatively crucial participant.

I’m assuming this was due to painkillers, anyway. For all I know, that sensation of being a little detached from proceedings and not especially worrying about immediate outcomes may have been caused by cratered blood pressure or other medical or even psychological phenomena.

Whatever the reason, I felt able to follow events closely but without much emotional distraction—an experience comparable to watching a high-quality game of football between teams you don’t support or have money on. Again, judging by other accounts, this is far from a unique occurrence.

It could even be a form of in-built protective mental barrier, common to all of us and deployed in moments of unendurable stress. You know, just like the way a human brain allows fingers to achieve extraordinary precision and dexterity when speeding past SBS channels on a remote. A person is only designed to handle so much.

That line about me being able to “follow events closely”; let’s pull that back for review, because I can’t have been all that attentive. I somehow completely missed the turning point, when the combined, enormous efforts of all those medics to keep me viable shifted to a more passive, observational role. They’d won.

I also missed, or simply can’t remember, much of what happened shortly before I was loaded on to a helicopter and sent to a specialist cardiac facility. The team at my local hospital, which is not equipped with all the fancy heart-fixin’ gear, had done absolutely everything they’d needed to do before shifting me on to the next venue. 

They’d kept a few strategies in reserve, too. This I do remember: an attending doctor told me, very soon after I’d been satisfactorily stabilised and was essentially in the clear, that she’d just signed off on the drugs they planned to use “when your heart stopped”.

Thanks to them, it never did. 

Specialist surgery followed, then time in intensive care, then weeks of recovery—still continuing. But it’s all positive, including the latest medical assessments. And now I have something else to chat about with my uncle. For both of us, the least painful elements of our cardiac crises were those damned heart attacks themselves.

Now if only we could find a way to subtract the pain from living under a Labor government, paying for the ABC and hearing Kamala Harris. I guess even the most advanced medical science has its limits.